The impact of treatment processes on depression and anxiety outcomes in behavioral health treatment: a retrospective analysis

Abstract

Anxiety and depression are prevalent mental health disorders, but traditional treatments often have limited effectiveness. Process-Based Therapy (PBT), which targets the underlying mechanisms driving these conditions, offers a promising alternative. The purpose of this retrospective study was to examine how processes of change relate to changes in anxiety and depressive symptoms in patients with elevated anxiety and/or depression symptoms who underwent PBT at Lightfully Behavioral Health, a behavioral health treatment clinic. This retrospective study analyzed data from adults (≥ 18 years) with elevated anxiety (n = 396) and depression (n = 434) who received treatment at Lightfully Behavioral Health, a PBT-based behavioral health treatment clinic. Mental health symptoms and PBT processes (i.e., psychological inflexibility, emotion dysregulation, thwarted belongingness, self-compassion, and personal values alignment) were measured at admission and discharge. Multiple logistic regression models, including stepwise models, tested associations between changes in processes and achievement of remission at discharge (yes vs. no) among those with elevated anxiety and depression. Bayesian structural equation models assessed whether changes in processes mediated the relationship between treatment dose and achieving anxiety and depression remission. Improvements in all PBT processes were related to achieving anxiety and depression remission (p < 0.001). However, only improvements in self-compassion (OR 2.92, p < 0.001) and psychological inflexibility (OR 1.05, p = 0.007) were associated with greater likelihood of achieving anxiety symptom remission, and self-compassion (OR 2.33, p < 0.001), alignment with personal values (OR 1.06, p = 0.006), psychological inflexibility (OR 1.08, p < 0.001), with greater likelihood of achieving depression symptom remission. Self-compassion was supported as a mediator in the relationship between treatment dose and anxiety remission, while both self-compassion and psychological inflexibility were supported as mediators for depression remission, as their 95% credible intervals excluded zero. Self-compassion and psychological inflexibility may be important for the remission of anxiety and depression symptoms among patients receiving PBT. These findings suggest that changes in self-compassion and psychological inflexibility are associated with remission and may represent important targets for intervention. While this study contributes to the limited evidence on PBT, further research is needed to better understand the long-term effects of these therapeutic processes.